As Seattle-area hospitals are canceling elective procedures, running low on medical supplies, and bracing for the impact of escalating coronavirus cases, you might be wondering: What's it like in maternity wards right now?
"As you can imagine, births are still happening," said a nurse who works in a local hospital delivering babies. "We're only having more babies all the time."
The hospital where this person works delivers hundreds of babies a month. It's also a hospital that has seen multiple coronavirus cases. Typically, the maternity ward is a celebratory place, and patients can have as many visitors as they want. But COVID-19 means new rules and restrictions.
"Normally we have super minimal personal protective equipment," said the nurse I interviewed, who agreed to talk to The Stranger on condition of anonymity. "Right now we have only three days of gloves left. Because people are stealing them. People are hoarding them. That's why the government is saying: 'Please stop hoarding these. Please stop stealing these.' Because imagine delivering a baby without gloves. It's a messy business."
Before entering the hospital, people going into labor are screened by phone and asked about symptoms: Any respiratory issues? Fever? Shortness of breath? Diarrhea? Have any of their family members traveled to high-risk areas or been in contact with someone who's COVID-19 positive? If the answer is yes to any of those questions, they have to be screened in person outside of the hospital as well, where they might be met by medical staff wearing a PAPR, a negative-pressure suit that looks like a hazmat suit, or a spacesuit. "And we bring a mask for the patient," the nurse said.
If the patient does have any COVID symptoms, they are classified as a PUI (person under investigation), and they go to a special area of the maternity ward that has negative-pressure rooms. A negative-pressure room is basically "a double door system. One door closes, you enter an antechamber, and a second door opens. It keeps the air in that room separate from the air in the rest of the hospital. So it's less pressure inside that room than the rest of the hospital, effectively meaning air can only come in, air can't get out of the room. That's the same idea of a PAPR suit—the suit keeps [the health care worker wearing it] in a negative-pressure state. So the PAPR suit is an alternative if you don't have a negative-pressure room."
Many people going into labor come to the hospital with potential COVID symptoms, and since the Seattle area has been the epicenter of the US outbreak, exposure to the coronavirus is not unlikely. "Most people are PUIs, because we're assuming positive until proven otherwise." Why assume? Does the hospital not have enough tests to find out for sure? "No one does. No one has enough tests. That's nationwide." Even if the hospital decides to go ahead and test a particular patient, results can take 48 hours—by which point the baby may already be born.
As for the childbirth itself: "Standard practice is skin-to-skin contact immediately following delivery. Typically you catch the baby and plop it on the mom's belly. It's still connected to the umbilical cord and placenta. And she can reach down and touch the baby. We wait until the baby gets all of the blood flow from the placenta, and then we clamp and cut the cord and bring the baby to the mom's chest. All the research suggests that physiologically that's the best thing for both of them."
But if the mom is a PUI or is COVID-positive, the recommendation from the American College of Obstetrics and Gynecology (ACOG) is that medical staff should maintain social distancing of at least six feet between the mom and the baby.
In other words, "Not to do skin-to-skin contact. And the mom goes through labor in a mask. Can you imagine going through natural childbirth, breathing, working, in an air mask the whole time? And then we deliver, and we try to keep them separate from each other."
COVID-19 cannot be transmitted from mother to baby through the bloodstream, nor through breastmilk. The only way it could be transmitted is if droplets from the mother's mouth or nose enter the baby's respiratory system.
These days in hospitals, the normal practice is rooming-in, meaning that the baby stays in the room with mom (the days of babies being whisked off to some other room in maternity wards are a thing of the past). Especially important, according to data, is "the golden hour" right after a baby is born. Not having that skin-to-skin contact during the golden hour can increase the risk of postpartum mood disorders in the mother.
But social distancing is considered more important right now, because "babies when delivered have a pretty immature immune system. They're in with that super-high-risk population." Of course, there are a lot of unknowns about COVID-19, which the ACOG recommendations acknowledge: "Due to the limited data on COVID-19, these recommendations are largely based on infection prevention and control considerations for other respiratory viruses such as influenza, SARS-CoV, and MERS-CoV and are intentionally cautious as experts learn more about this new virus."
If possible, the medical staff will isolate the baby from the mother, the nurse said. "We try to have them in separate rooms. But the minimum is six feet with the mom continuing to wear a mask, and handwashing often." Because COVID-19 can't be transmitted through breastmilk or blood, the birthing process itself is safe. But the ACOG recommendation is to have the mom pump and then give that expressed breast milk to her partner or a health care provider to feed to either bottle-feed or spoon-feed the baby.
"There's also a lot of PTSD associated with how women perceive their treatment while they're in labor," the nurse said. "We work really hard to minimize that by normalizing the process, being really open and transparent with our communication, and making sure they have autonomy through the process. So balancing all that with isolation practices is really strange."
Because birth-givers have been preparing for this day for months or years, they come to the hospital with a lot of ideas about how it's going to go. "People read so much and prep so much for their birth, and they read Goop lab and everything else, and when they come in and say 'Well Gwyneth Paltrow says this...' it's really frustrating." But now such confusions are infinitely worse, because overly dramatic media reports about coronavirus are misleading expectant parents into states of frenzy. "Public information, media reports, even what the government is saying is sometimes not aligning with the CDC recommendations, and so it's exhausting to have to constantly reeducate," the nurse said.
"There are patients who come in who are totally healthy, and they say, 'I want to wear a mask,' and they want everyone else in a hazmat suit, and it's just not an option. And some people are like: 'I'll go to another hospital.' And it's like, 'You have the right to do that, but it's going to be the same everywhere. You're not at risk [at the hospital]. We're healthy.'"
Does this nurse have any worries about contracting COVID-19? "I don't have any. It's annoying to say this, but it's really coming down to washing your hands a ton and not touching your face. Healthy, middle-aged people ultimately should be okay, and we're also taking all of the steps recommended."
What's bizarre, the nurse said, is the difference in the level of fear within the hospital, where there actually are patients with COVID-19 but the medical professions are not afraid, compared to the level of fear outside the hospital, where people are stocking up on groceries like it's the apocalypse.
"Amongst health care staff, we really feel like this is serious, and these are the steps that need to be taken. But the more overwhelming thing is that public panic is creating grocery store madness, and businesses shutting down, and the glove shortage. It feels well-controlled and well-managed at the hospital, and then you go to Trader Joe's and it's like: What the hell is going on here? When we're at work, we're like, 'Are we going to be screwed when we leave this 12-hour shift? Are we going to be able to get groceries? And toilet paper?' We don't understand why toilet paper is such a concern."
Asked about what it's like to do this job at this particular moment in time, the nurse said, "It's really special. We typically all love what we do, and we have a really special type of job. I also think that most new parents are really great at trusting our expertise and wanting to do the right thing, so they're compliant. I haven't seen anyone who's not compliant with our recommendations." When the mom and baby can bond, with skin-to-skin contact, it's a relief. "That's our ultimate thing. We're just trying to keep this as normal as we can."
But babies being born to COVID-positive parents are still healthy babies? "Totally. There's nothing different about them."